REQUEST AND AUTHORIZATION FOR ACCESS TO RESTRICTED ARCHIVAL RECORDS HELD IN THE NATIONAL CAPITAL REGION UNDER LAC’S CONTROL

“Departmental Letterhead”                                                                            PROTECTED (when completed)

Date: ___________________

ATIP Coordinator
ATIP & PR Division
Library and Archives Canada
395 Wellington, Room 349
Ottawa, Ontario
K1A 0N4

RE: Request to access restricted archival records created by _________________________________________
(Name of Department)

May I present ___________________________, telephone number:  _________________, her/his LAC’s user card number:  __________________________ , an (indeterminate employee/ term employee/ consultant/ general researcher).  S/he has (enhanced reliability/ secret or top secret security clearance).  In order to carry out his/her duties, s/he will need access until ___________________ (YYYY/MM/DD - maximum one year or length of term/contract) to (all/ the following) restricted archival records created by our office:

(Identify the restricted archival records as precisely as possible, by (the fonds or record group number, the accession number or the container number (volume or box) or the microfilm number, and the file or item number)
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

This permission (does/ does not) include the right to order photocopies, as required, at our expense.  

I understand that these restricted archival records shall not be removed from the premises of Library and Archives Canada.

Director, _________________________

Business address:

Telephone number: